Pega Smart Claims (5+ Years Experience)

Pega Smart Claims (5+ Years Experience)

Key Responsibilities

• Design, develop, and implement solutions on Pega Smart Claims platform for insurance/healthcare domain.

• Configure and customize Pega rules, flows, case types, data pages, activities, decision tables, and integrations.

• Work closely with business stakeholders to gather requirements and translate them into functional and technical solutions.

• Enhance and optimize claims processing workflows to improve accuracy and reduce turnaround time.

• Perform unit testing, debugging, and defect resolution for Pega Smart Claims applications.

• Collaborate with cross-functional teams (QA, Business Analysts, Architects) to deliver high-quality solutions.

• Provide production support and resolve issues within SLAs.

• Ensure compliance with Pega best practices and coding standards.

Required Skills

• Minimum 5 years of hands-on experience in Pega PRPC with focus on Smart Claims (Healthcare/Insurance domain preferred).

• Strong knowledge of Pega Case Management, BPM concepts, and Claims processing workflows.

• Experience with integrations (SOAP/REST APIs, MQ, Web Services).

• Good understanding of claims adjudication, provider/member data, and insurance domain processes.

• Knowledge of Pega Guardrails, Ruleset Management, and Application Lifecycle Management (ALM).

• Familiarity with Agile methodology and DevOps tools for CI/CD in Pega projects.

Good to Have

• Pega certification such as CSA (Certified System Architect) or CSSA (Certified Senior System Architect).